Embodiments herein generally relate to Electronic Medical Records (EMR) systems and more specifically to a method and system that use checkboxes on pre-printed forms to control the flow of images and the transcription of handwritten notes.
During a patient visit, the health care provider first review the patient's medical record, examines the patient noting any important information that comes to light, then updates the patients medical record with the new information. Most physicians use paper medical records; however, such systems are being replaced by Electronic Medical Records (EMR) because EMR has significant advantages, and cost savings. One disadvantage of such electronic records systems is that they slow down health care providers and make them less efficient. Another disadvantage is that the process of entering the data into the EMR while that patient is present can interfere with the patient-health care provider interaction. Some healthcare information technology providers estimate that they can see only 80% of the patients they saw before the introduction of EMR and that some health care providers leave a practice when an EMR is installed.
Reasons for this reduction in efficiency are numerous. For example, some health care providers find that data entry can interfere with health care provider patient interactions. Interacting with a form and a computer monitor requires the health care provider to focus visual attention on the screen. However, notes can be jotted on a paper form without breaking eye contact. In addition, if the wrong form is presented by the EMR, the health care provider may need to spend time searching for the appropriate form. The wrong form is often presented when a patient has multiple complaints. With a paper form, the health care provider can jot notes on the form while interacting with the patient and transfer the information to the correct form after the patient leaves. In addition, old-fashioned paper forms are still useful because health care providers can preserve current work practices. With proper forms, the health care provider does not need to learn a new way of entering data
In view of such issues, the embodiments described herein provide a method and system that allows health care providers to interact with the paper systems (where they may be most effective) while preserving the EMR system for the benefits it provides. These benefits rely on the data being interpretable by the machine, which limits the effectiveness of images because, without metadata (i.e. machine interpretable data describing the semantics of the images) the semantics of such information cannot be processed by the machine. More specifically, a method embodiment herein prints a selected form designed to collect data using standard work flows that minimize impact on the health care provider-patient interaction. The form has printed thereon machine readable data identifying the entity (e.g., barcodes, glyphs, etc.); machine readable selection items relating to data to be captured by the form (checkboxes, etc.); and spaces for handwritten text, which can be lined or just blank space.
During the examination, the health care provider marks the form with notes. After the examination, the form is scanned to form an image which is stored and associated with the patient's record. The image is further processed to update the EMR and, potentially, handwritten elements may be sent to transcribers for information extraction. Different elements on the form are segregated depending on the processing they require.
The marks on the form are interpreted in one of three ways: they may be interpreted as data that is to be inserted directly into the EMR, they may be interpreted as images that are to be stored, possibly for further processing, or they may be interpreted as instructions for further processing of the other marks on the form.
For example, handwritten notes are currently difficult for machines to interpret so the handwritten notes the health care provider makes may be stored as images of the handwriting, which may be forwarded to transcribers to be entered as data. Other types of marks that machines are able to interpret, such as check boxes or numerals, may be transformed by the machine into machine interpretable data and entered into the data portion of the EMR. As an example of such interpretation, the health care provider may select a check box that indicates a primary diagnosis to be entered into the EMR. The marks the machine is able to interpret may also be transformed into machine interpretable data and stored as metadata with associated images.
The machine interpretable marks may also indicate special processing for other marks on the form. For example, in response to checkbox selections (or other user added markings) on the machine readable selection items, the method can ignore certain information on the form, so, if the user found that the incorrect form had been printed, the user could make handwritten notations on the form to tell the system (by checking the appropriate box) that none of the pre-printed machine readable selection items should be considered, regardless of whether any of the other boxes had been inadvertently checked, and that only the handwriting should be utilized.
In addition, when analyzing the scan file, the method can determine whether the user added handwritten text in the spaces available for handwritten text. If user added handwritten text is present, the method operates in response to the checkmarks (the user added markings) on the machine readable selection items regarding how to process such handwriting. Such checkmarks can cause the system to maintain only an image of the user added handwritten text, which is less expensive. Alternatively, the checkmarks can instruct the system to not only maintain an image of the user added handwritten text, but to automatically forward the image of the user added handwritten text to a transcription center, so that the handwritten text can be transcribed into the electronically storable data relating to the entity, which is more expensive. The transcription of the handwritten text can include performing manual transcription and/or performing automated handwriting recognition.
Therefore, the use of the checkboxes allows the user to be cost efficient in transcribing only the material that justifies the added transcription expense. However, as the embodiments herein only supply this instruction to transcribe through the form's checkboxes, and do not require any computerized or manual instruction to perform expensive transcription, the system is highly efficient and produces cost savings.
The electronically storable data relating to the entity that is obtained from the checked machine readable selection items and from the transcribed handwritten notes can be output to a database that maintains information regarding the entity. The transmission of the images of the user added handwritten text and the electronically storable data can be performed by transmissions over a computerized network. If a completely paperless system is utilized, the method can destroy the form after the form is scanned.
In addition, the embodiments herein include system embodiments. System embodiments will use a printer connected to a processor, an electronic memory (also connected to the processor) that maintains a form repository and a database, and an electronic record system (also connected to the processor). The electronic record system has the capability to manage the database and direct the printer to print forms from the form repository. Again, such forms relate to a specific entity, and the forms include machine readable data identifying the entity, machine readable selection items relating to data to be captured by the form, and spaces for handwritten text. In particular, the printed form will contain machine readable data that indicates which electronic medical record the data captured from the form should be associated with. It may also include data such as the date of the visit and the health care provider performing the examination.
The system embodiments will also include a scanner (connected to the processor). After the markings have been placed on the form by the health care provider who interacted with the patient, the scanner scans the form to produce a scan file. A shredder can be used to destroy the form after the form is scanned.
The electronic record storage system analyzes the scan file to identify whether user added markings are present on the machine readable selection items. The electronic record storage system obtains the electronically storable data relating to the entity based on the marks on the checkboxes (user added markings) on the machine readable selection items.
The electronic record storage system also determines whether user added handwritten text is present in the spaces for handwritten text. If the user added handwritten text is present, the electronic record storage system takes different actions in response to which checkboxes are marked. If certain boxes are checked, the electronic record storage system will maintain only an image of the user added handwritten text (to save costs). Alternatively, if other checkboxes are checked, the electronic record storage system will maintain an image of the user added handwritten text, and also automatically forwarding the image of the user added handwritten text to a transcription center. The actions indicated by the checkboxes (or other machine interpretable marks) are driven by the processing specified by machine interpretable marks printed on the form.
The transcription center transcribes the handwritten text into additional machine interpretable data relating to the entity. The transcription center comprises a manual transcription station and/or an automated handwriting recognition station. The electronically storable data is then output to the database over a network. The image of the user added handwritten text is also transmitted over the network to the transcription center.
As described in U.S. Patent Publication 2007/0183688 (the complete disclosure of which is incorporated herein by reference) the acquisition, storage and correlation of certain types of data may prove difficult in certain circumstances. The example used in that patent publication relates to capturing insurance adjusters written notes and photographs, however, the techniques taught by this publication are also applicable when processing medical notes.
These and other features are described in, or are apparent from, the following detailed description.